Plan Benefits and Cost Sharing

Plan Benefits and Cost Sharing 

For the benefit year of 2017 here is what you’ll get and what you will pay:

Benefits

  • Doctor Visit: $0
  • Vision Care: $100 limit every two years for contact lenses and eyeglasses (frames and lenses)
  • Dental Services provided by Delta Dental: $0 copay. Use this coverage for either preventive or comprehensive dental services
  • Inpatient Hospital Care: $0
  • Home Health Agency Care: $0
  • Ambulance Services: $0
  • Transportation: $0 (30 one-way trips per year) Call American Logistics Company (ALC) at 1-866-880-3654. For TTY users, call your relay service or California Relay Service at 711. For reservations call Monday-Friday, 7am-6pm (PST). Call at least 24-hours before your appointment. 
  • Diagnostic Tests, X-Rays & Lab Services: $0
  • Durable Medical Equipment: $0
  • Home and Community Based Services (HCBS): $0
    • In Home Support Services (IHSS): $0
    • Community Based Adult Services (CBAS): $0
    • Multipurpose Senior Service Program (MSSP): $0
  • Long Term Care that includes custodial care and facility: $0

Cost-Sharing
Cost-Sharing refers to amounts that a member has to pay when services or drugs are received. Co-pays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.
  • Tier 1: Generic prescription (including brand drugs treated as generic): $0, or $1.20, or $3.30
  • Tier 2: Brand name prescription: $0, or $3.70, or $8.25
  • Tier 3: Non-Medicare/OTC drugs: $0

After your coverage begins with IEHP DualChoice you must receive medical services and prescription drug services in the IEHP DualChoice network.

To learn more about the plan’s benefits, cost-sharing, applicable conditions and limitations, refer to the IEHP DualChoice Member Handbook.

The Multi-Language Insert is a document that contains information regarding free interpreter services and how to access these services translated into multiple languages. 

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. By clicking on this link, you will be leaving the IEHP DualChoice website.

Plan Premium
There is no plan premium for IEHP DualChoice.

Plan Deductible
There is no deductible for IEHP DualChoice.

Who can join
View the Who Qualifies section to see who is eligible for IEHP DualChoice.

Please call IEHP DualChoice Member Services for more information at 1-877-273-IEHP (4347) 8am-8pm (PST), 7 days a week, including holidays. TTY/TDD users should call 1-800-718-4347. 

Because you are eligible for Medi-Cal, you qualify for and are getting “Extra Help” from Medicare to pay for your prescription drug plan costs. You do not need to do anything further to get this Extra Help. 

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
  • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; 
  • Your State Medicaid Office
IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. Limitations, copays, and restrictions may apply. Copays for prescription drugs may vary based on the level of Extra Help you receive. Benefits and copayments may change on January 1 of each year. The List of Covered Drugs and pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you. For more information, call IEHP DualChoice Member Services or read the IEHP DualChoice Member Handbook.

Information on this page is current as of September 30, 2016
H5355_CMC_17_07258 Approved